Middle East Management Office

HSBC Tower, Downtown Dubai

PO Box 55, U.A.E.
www.hsbc.ae

Branch Name: ..................................................................................................................................................................... ........................................................................................................................................................................................

RE: Address Confirmation of: ..................................................................................................................................................................... ...............................................................................................................................

<Insert Name of supplementary cardholder / joint account holder>

Customer Name: ..................................................................................................................................................................... ..................................................................................................................................................................................

Account Number: ..................................................................................................................................................................... ......................................................................................................................................................................... ....

Residential Address within UAE (if applicable): .............................................................................................................................................................................................................................. ....

..................................................................................................................................................................... ......................................................................................................................................................................................................................................................

Residential Address outside UAE (if applicable): .............................................................................................................................................................................................................................

..................................................................................................................................................................... ........................................................................................................................................................................................................................................................

Relationship : Spouse Child Other (please specify) ___________________

Document Attached : Utility Bill

Please provide any one of the following Only if it specifies the actual physical address of residence/company and is dated within the last 4 months
Valid Tenancy Contract

Letter from Employer

Specifying the actual physical address & PO Box of office premise

Bank Statement
Only if it specifies the actual physical address of residence/ company & is dated within the last 4 months
Other (please specify) ___________________________

I, hereby declare that the information provided above and the documents supplied are true and correct,
and authorise HSBC Bank Middle East Limited to verify this information from whatever sources it may
choose.

In the event of a change of residential address, under any circumstances, I understand that a document(s)
evidencing the new residential address or addresses (in case of different addresses) is required to be
submitted to you for each account holder / supplementary cardholder.

Customer name: ..................................................................................................................................................................... ............................................................................................................................................................................................

Signature: /
...................................................................................................... .............................................................. ...................................... Date Signed: ............................................................ ........................... ......... ...........................
To be signed by both parties, if joint account

HSBC Bank Middle East Limited

© Copyright. HSBC Bank Middle East Limited 2015 ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, on any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of HSBC Bank
Middle East Limited.
Issued by HSBC Bank Middle East Limited, U.A.E Branch, PO Box 66, Dubai, U.A.E, regulated by the Central Bank of the U.A.E and lead regulated by the
Dubai Financial Service Authority. CRN 091719